Research Activities, April 2012: Elderly/Long-Term Care: Improving quality of care for falls and urinary incontinence also improves quality of life in elderly patients
Improving quality of care for falls and urinary incontinence also improves quality of life in elderly patients
Urinary incontinence (UI) and falls, conditions common in the elderly, can produce considerable disability, morbidity, and decreased quality of life. When recommended care is used for these two conditions, patients report better quality of life outcomes, according to a new study that used data from a practice-based educational intervention to improve recommended care.
Lillian C. Min, M.D., M.S.H.S., of the University of Michigan Medical School, and colleagues analyzed care and outcomes for 133 ambulatory care patients with urinary incontinence and 328 patients with falls or fear of falling. All were 75 years of age or older and participants in the Assessing the Care of Vulnerable Elders Study-2. The intervention to improve recommended care for the conditions at two large medical practices included physician education, structured visit notes that guided physicians to provide recommended care, and community resource and education handouts for participants. Both practices included intervention and control groups.
The researchers examined the association between quality of care patients received for the two conditions and their outcomes. Quality-of-care indicators for UI included taking a UI-specific history, examination, and urinalysis, and checking postvoid residual, discussing treatment options, and recommending behavioral interventions before medication treatment. Quality indicators for fall patients were also studied. Patients who had fallen twice in the past year or once with an injury requiring medical attention should receive a fall-specific history and a gait and balance exam. Those who feared falling should have a gait and balance examination. Those with poor balance should be considered for physical therapy or assistive device and those with abnormal gait should be considered for physical therapy. For every 10 percent increase in the receipt of quality care for UI, there was an improvement of 1.4 points on the Incontinence Quality of Life score, indicating fewer bothersome symptoms. There was also a small improvement in falls or fear of falls when better quality of care for falls was implemented. These findings should encourage primary care practices to pay more attention to providing effective interventions for UI and fall prevention in order to improve patients' quality of life. The study was supported in part by the Agency for Healthcare Research and Quality (HS17621).
See "Does better quality of care for falls and urinary incontinence result in better participant-reported outcomes?" by Lillian C. Min, M.D., M.S.H.S., David B. Reuben, M.D., John Adams, Ph.D., and others in the August 2011 Journal of the American Geriatric Society 59, pp. 1435-1443.